Sonic Diagnosis

Summary

Podcast Summary: Twenty Thousand Hertz - Episode "Sonic Diagnosis"

Podcast Information

• Title: Twenty Thousand Hertz
• Host: Dallas Taylor
• Description: The stories behind the world's most recognizable and interesting sounds.
• Episode: Sonic Diagnosis
• Release Date: August 21, 2024

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Introduction

In the "Sonic Diagnosis" episode of Twenty Thousand Hertz, host Dallas Taylor delves into the intricate relationship between sound and medicine. He begins with a personal anecdote about being in an anechoic chamber, one of the quietest places on Earth, where he could distinctly hear his own bodily sounds.

"A few years ago, I was locked into an anechoic chamber, which is one of the quietest places on Earth. While I was inside, I could hear my heartbeat super clearly, I could hear the blood rushing through my veins, and I could hear my digestive system."
— Dallas Taylor [00:01]

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Historical Perspective on Medical Listening

Dr. David Steensma, an expert in blood cancers and medical history, alongside Dr. Daniel Weiss, a cardiac specialist, explore the long-standing tradition of doctors listening to patients' bodies to diagnose ailments.

"Sounds like these contain critical information about our health."
— Dr. David Steensma [01:26]

They trace the roots back to ancient Greek medicine, highlighting Hippocrates' early use of auditory diagnosis.

"If you look back at the ancient Greek world from 2000 plus years ago, you see references to listening to the patient's body."
— Dr. Daniel Weiss [02:04]

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Evolution of the Stethoscope

The conversation shifts to pivotal developments in medical listening tools, particularly the stethoscope. Dr. Steensma discusses the innovation introduced by Leopold Auenbrugger in the 18th century, who adapted a percussive technique from his father's method of gauging wine levels in casks.

"Ahn Brugger was the son of an innkeeper. When he was a boy, he'd watch his father try to work out how much wine was left in casks by knocking on them with his knuckles."
— Dr. David Steensma [03:14]

Dr. Weiss elaborates on how Auenbrugger's technique allowed for diagnosing fluid buildup in patients' lungs by auscultation.

"He could hear a dullness on the left, but an echo on the right, that would help him diagnostically."
— Dr. Daniel Weiss [03:39]

The discussion moves to René Laennec, who in the early 19th century invented the first true stethoscope after encountering social and practical challenges in auscultating a young, obese female patient.

"Laennec thought he might be able to do something similar with his patient... placed one end on her chest, and listened through the other."
— Dr. David Steensma [06:02]

This innovation revolutionized medical diagnostics, leading to the modern stethoscope's design with dual rubber tubes and interchangeable components.

"The wooden cylinder was replaced with two rubber tubes, one for each ear, and different attachments were developed for the end that goes on the patient."
— Dr. David Steensma [07:38]

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Modern Innovations in Medical Hearing

The episode highlights advancements such as electronic and specialized stethoscopes. Dr. Weiss shares his personal experience transitioning to an amplified stethoscope after partial hearing loss, emphasizing the enhanced clarity it provided.

"I lost part of my hearing in my left ear... I couldn't believe how much of a world that it opened up again for me."
— Dr. Daniel Weiss [15:58]

Fran Bord, the producer, discusses the development of specialized stethoscopes designed for specific body parts, such as the carotid artery, to capture more precise sounds.

"We developed a version of that stethoscope that kind of looks like a bent straw, so you can really get it into the space there and get a really good sound capture."
— Fran Bord [18:20]

The team also explores recording swallowing sounds, identifying five distinct stages that can indicate potential health issues.

"We were able to record and hear all five components clearly with our stethoscope. And we noticed that if the first three sounds are present in their proper order, there is basically never a problem."
— Fran Bord [20:01]

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AI and Future Directions

The integration of artificial intelligence (AI) into stethoscope technology marks a significant leap forward. Dr. Steensma and Fran Bord discuss AI's role in analyzing sounds to provide diagnostic suggestions, surpassing even expert physicians in certain areas.

"AI is already beating the human experts in diagnosing this condition."
— Dr. David Steensma [23:07]

However, there's an emphasis on maintaining the human element in medicine. Fran Bord stresses the importance of doctors understanding AI processes to prevent it from becoming a "black box."

"They want to understand what is that system doing, how is it making that decision and has to make sense to them."
— Fran Bord [23:23]

Dr. Weiss reflects on the balance between embracing new technologies and preserving traditional diagnostic skills.

"It is both an art and a science."
— Dr. Daniel Weiss [24:16]

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Conclusion

The episode concludes by reaffirming the enduring significance of sound in medical diagnostics, even as technology evolves. Dr. Weiss shares a personal story illustrating the nuanced expertise of seasoned physicians, emphasizing that the human "ear" remains indispensable.

"Not all sound driven diagnosis is through an instrument. Sometimes it's just using the instruments that are on the side of our heads."
— Dr. Daniel Weiss [25:24]

Dallas Taylor wraps up the episode by reiterating the profound impact of sound in medicine, bridging ancient practices with cutting-edge technology.

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Notable Quotes with Timestamps

• Dallas Taylor [00:01]:

  "A few years ago, I was locked into an anechoic chamber, which is one of the quietest places on Earth..."

• Dr. David Steensma [01:26]:

  "Sounds like these contain critical information about our health."

• Dr. Daniel Weiss [02:04]:

  "If you look back at the ancient Greek world from 2000 plus years ago, you see references to listening to the patient's body."

• Dr. David Steensma [03:14]:

  "Ahn Brugger was the son of an innkeeper..."

• Dr. Daniel Weiss [07:38]:

  "The wooden cylinder was replaced with two rubber tubes..."

• Dr. Daniel Weiss [15:58]:

  "I lost part of my hearing in my left ear..."

• Fran Bord [18:20]:

  "We developed a version of that stethoscope that kind of looks like a bent straw..."

• Dr. Daniel Weiss [24:16]:

  "It is both an art and a science."

• Dr. Daniel Weiss [25:24]:

  "Not all sound driven diagnosis is through an instrument..."

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Key Takeaways

• Historical Significance: Listening to body sounds has been a cornerstone of medical diagnostics since ancient times, evolving significantly with innovations like the stethoscope.

• Technological Advancements: Electronic stethoscopes and AI integration are enhancing diagnostic capabilities, allowing for more precise and efficient evaluations.

• Human Element: Despite technological progress, the expertise and intuitive skills of physicians remain crucial in interpreting sounds and making informed diagnoses.

• Future Potential: Ongoing developments promise even more sophisticated tools, potentially uncovering previously unheard sounds that could lead to groundbreaking medical insights.

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For those fascinated by the intersection of sound and science, "Sonic Diagnosis" offers an enlightening exploration of how something as fundamental as listening can shape the medical field's past, present, and future.

Transcript

[Dallas Taylor]

This episode is brought to you by OnePlus, who just launched their new OnePlus Buds Pro 3 earlier this year. You might have heard me talk about their last model, the OnePlus Buds 3, and while those are still really solid, this pro version contains a lot of new features that are definitely worth the upgrade. I've been using them for a few weeks now and I've been really impressed. Just like the Buds 3, the bass in these earbuds is super powerful, but in this model, the treble is more crisp and precise than ever before. All of my favorite music sounds great, no matter the genre, and if I ever want to fine tune the sound, I can use the OnePlus Hey Melody app to choose a different EQ preset. But it's not just about the sound they make, it's about the sound they block out. OnePlus Buds Pro 3 block more sound than ever before with a brand new noise canceling system. It's one of the best I've used, and it's a big step up from the last version. I'll break down these upgrades during the break. You're listening to 20,000 hertz. I'm Dallas Taylor. A few years ago, I was locked into an anechoic chamber, which is one of the quietest places on Earth. While I was inside, I could hear my heartbeat super clearly, I could hear the blood rushing through my veins, and I could hear my digestive system.

[Dr. David Steensma]

Sounds like these contain critical information about our health.

[Dallas Taylor]

That's 20,000 hertz. Producer Fran Bord Today, there are all.

[Dr. David Steensma]

Kinds of tools for capturing the sounds that our bodies make, but doctors have been listening to them for millennia.

[Dr. Daniel Weiss]

If you look back at the ancient Greek world from 2000 plus years ago, you see references to listening to the patient's body.

[Dr. David Steensma]

That's Dr. David Steensma. He's an expert in blood cancers and disorders, and he's also a big medical history buff.

[Dr. Daniel Weiss]

I'd always been quite interested in history as a way of understanding the present.

[Dr. David Steensma]

David says that Hippocrates, who's also known as the father of medicine, was really into sound.

[Dr. Daniel Weiss]

It was clear even in the Hippocratic times that they would put their ears up to the chest wall or the belly of the patient and listen. And certain sounds would suggest certain diagnoses.

[Dr. David Steensma]

For example, Hippocrates realized that if he shook patients by their shoulders and then listened to the sounds coming from their chest, he could tell whether they had any fluid buildup in there. Of course, in past centuries, doctors had fewer medical tools to work with but there's one listening technique in medicine that doesn't require any special equipment. It's called percussion.

[Dr. Daniel Weiss]

It's the same sort of thing that you would use to try to find, say a stud in a wall. By tapping along the wall with your finger or with an instrument, you hear an echo until you get over the board underneath and then you hear a bit of dullness. And there was a physician in the 18th century, Leopold Auenbrugger, who really brought this technique into medicine.

[Dr. David Steensma]

Ahn Brugge was the son of an innkeeper. When he was a boy, he'd watch his father try to work out how much wine was left in casks by knocking on them with his knuckles.

[Dr. Daniel Weiss]

There would be a shift in the sound that would happen at the fluid level and he would know this one's full, this one's nearly empty, this one's in between.

[Dr. David Steensma]

Once Armbrugger became a doctor in Vienna, he brought the tapping technique with him.

[Dr. Daniel Weiss]

He started using this same percussion technique to measure fluid levels of and patients. For instance, if it was thought that perhaps the patient's left lung was surrounded by fluid or filled with fluid, Auenberger could percuss and he'd hear a dullness on the left, but an echo on the right, that would help him diagnostically.

[Dr. David Steensma]

Ahnbrugger's new listening technique took a while to catch on. Back then it was actually pretty rare for doctors to train via hands on time with patients. Most of their learning was done purely from books. It was even common for doctors to diagnose people by letter without ever having met them.

[Dr. Daniel Weiss]

He published this and it was really largely ignored until Napoleon's favorite physician, a guy named Jean Nicolas Corvisart, who was really trying to rehabilitate physical diagnosis and move it into the modern era.

[Dr. David Steensma]

Corvisard was part of a larger movement in medicine that emphasized hands on training and hospital internships.

[Dr. Daniel Weiss]

So he came across Alan Brugger's writings and started to incorporate that in his own practice and teach it.

[Dr. David Steensma]

Eventually the percussive technique became standard practice.

[Dr. Daniel Weiss]

It's a technique that we still teach medical students in which there's still something being done in your local emergency room, probably right at this moment by a physician at the bedside.

[Dr. David Steensma]

Not long after Corvisa started bringing percussion to the masses, another French physician named Rene Lanec was busy working in Paris. One day a patient came into his office.

[Dr. Daniel Weiss]

He was asked to see a patient who had symptoms that were suggestive of heart disease. And normally the practice would be to put your ear to the chest wall and try to listen for heart sounds supplemented by percussion in the Alan Brugger style.

[Dr. David Steensma]

But in this case, Lenik was faced with two problems.

[Dr. Daniel Weiss]

One was that she was quite obese, and so when he would have tried to listen, it would have been muffled by intervening layers of fat. The other was that she was a young woman, and society had evolved in a way that was considered indecorous to put your ear, if you were a middle aged male physician, to the bosom of a young woman.

[Dr. David Steensma]

So he had to improvise.

[Dr. Daniel Weiss]

Laennec thought, what could he do to try to hear this woman's heart and chest cavity better? And he wrote later that he had seen some children playing a little game where one child would put their ear to a long wooden beam, and then the other would either talk into the beam or make some scratches on the beam. And the children noticed that the sound was conducted well by this wooden beam.

[Dr. David Steensma]

Laennec thought he might be able to do something similar with his patient. So he rolled a few dozen sheets of paper into a tube, placed one end on her chest, and listened through the other. To his excitement, he could hear her heart really clearly, even better than he normally could. Laennec knew he was onto something, but he wanted a tool that was hardier than paper.

[Dr. Daniel Weiss]

And as it turns out, his hobby was the flute. And he had carved some of his own flutes out of wood. And so he made a very simple wooden tube that took the place of that choir of paper and used that as an intermediary between. Between him and the patient's body.

[Dr. David Steensma]

This wooden tube was the first true.

[Dr. Daniel Weiss]

Stethoscope that became very popular because other physicians quite quickly saw the benefit of it.

[Dr. David Steensma]

Over the next few hundred years, the stethoscope evolved into the tool we recognize today. The wooden cylinder was replaced with two rubber tubes, one for each ear, and different attachments were developed for the end that goes on the patient.

[Dr. Daniel Weiss]

The first stethoscope that I bought in medical school and took on loans to be able to purchase had a bell and a diaphragm that you could flip.

[Dr. David Steensma]

Today, this design is pretty common for a stethoscope. The round metal piece usually has two sides to it. One side is a concave bell and the other is a flat diaphragm.

[Dr. Daniel Weiss]

The bell tends to be more useful for heart sounds, whereas the diaphragm can be more useful for certain types of murmurs and for listening to abdominal sounds because they tend to be higher pitched.

[Dr. David Steensma]

For such a relatively simple piece of equipment, the amount of information you can hear through a stethoscope is pretty amazing.

[Dr. Daniel Weiss]

There's just so much you can hear about the heart, the valves clicking murmurs if one of those valves doesn't open or shut properly, you can hear whether the heartbeat is irregular. You can hear certain echoes that happen when the heart is failing. You can hear when the heart is rubbing inside the sac that it lives in, if there's inflammation in that sac.

[Dr. David Steensma]

But it's not just the heart, there's also the lungs.

[Dr. Daniel Weiss]

You can hear wheezes if somebody's airways are narrowed, if the little air sacs, the alveoli, have fluid in them. You can hear them actually crackle as they open. It sounds just like somebody's stepping on one of those bubble wraps.

[Dr. David Steensma]

Doctors can also listen to blood vessels.

[Dr. Daniel Weiss]

If somebody's had a stroke, you can listen and maybe you hear whistling. That suggests turbulent blood flow in those arteries and that suggests the patient may have a narrowing. They may have an atherosclerotic plaque there.

[Dr. David Steensma]

And then there's the abdominal region.

[Dr. Daniel Weiss]

If you have somebody with a bowel obstruction and you put the stethoscope on the belly, you might hear very high pitched noises. Tinkles as the bowel is trying to squeeze past the obstruction. Or if the bowel is asleep, you might listen and hear no bowel sounds at all. That often happens after a surgical procedure, and the surgeon will then listen to the belly a few times each day to hear. Are the bowels waking up yet? Can I advance the patient's diet a bit once I'm starting to hear noise? Sometimes that noise is so loud that we can hear it outside our stomach's rumbling, as we say, a phenomenon called borborygmi, which is a technical name for rumbling stomach.

[Dr. David Steensma]

So the next time your stomach's rumbling, you can casually tell people, pardon my Borberg. As you can imagine, there's a lot of training that goes into deciphering this strange sonic language.

[Fran Bord]

Right now, when you go to medical school and you're handed your stethoscope, you're trained to do two things.

[Dr. David Steensma]

That's Dr. Daniel Weiss, a cardiac expert.

[Fran Bord]

One of them is passive capture of the sounds. Listen to the heartbeats. Have the patient take a breath in and out. Listen to the abdomen by putting the stethoscope on the stomach.

[Dr. David Steensma]

But that's not always enough. The sounds can be confusing.

[Fran Bord]

So sometimes we try to use physiology to help us with understanding the sounds. And that's particularly important when there are sounds that sound similar to the ear. We call them acoustic sound alikes, but in fact stem from different physiologic conditions.

[Dr. David Steensma]

This is why doctors often ask you to do different things while they listen through their stethoscope.

[Fran Bord]

Take a deep breath and hold it. Lie on your side. Sit up. Lie back. All these are designed to make subtle changes in the physiology that will make the sound get louder, softer. Whatever it is.

[Dr. David Steensma]

The stethoscope revolutionized medicine, and in popular culture, it's the quintessential medical accessory. Studies show that people even trust doctors more when they're wearing one. But today, the stethoscope is just one of an array of tools that doctors use for listening. Some of these devices give doctors superhuman listening abilities, where the tiniest little sounds can be captured and analyzed. These sounds can tell them all kinds of surprising things about their patient's health.

[Dallas Taylor]

That's coming up after the break. As a sound designer, a podcast host, and a general audio nerd, I've tried a ton of earbuds, and the OnePlus Buds Pro 3 have some really clever new technology crammed inside a tiny package. The Buds Pro 3 contain dual drivers, meaning each earbud has two speakers speakers inside it, a tweeter for the treble and a woofer for the bass. Both of these components have been upgraded from the last model, but one of the biggest changes is the new dual DAC technology. DAC stands for Digital to Analog Converter, and they're inside almost every piece of audio gear. Basically, it's what converts digital data into beautiful sound waves. With the OnePlus Buds Pro 3, there's now a dedicated DAC for the tweeter and another one for the woofer. This means that each speaker is precisely calibrated to the frequency range that it specializes in. As a result, you get exceptional audio at both ends of the scale. Another favorite feature of mine is the new Adaptive Active Noise Cancellation. It's an intelligent noise canceling system that adapts to changing sound levels. Not only does it increase the noise cancellation when you go somewhere loud, if you go somewhere quiet, it decreases it. This is actually really handy because having strong noise cancellation going on for long periods of time can cause some ear fatigue. But this adaptive mode gives you the exact amount of noise blocking you need, which is more comfortable and also saves battery life. These earbuds are also specifically designed to reduce the sound of voices. So if you're sitting on a restaurant patio trying to ignore the loud conversation behind you, just pop them in and you can enjoy your meal in peace. Finally, I was happy to see that one of my favorite OnePlus features is still included in the Buds Pro 3. It's an option called Golden Sound and it's basically a built in hearing test that calibrates the earbuds to your hearing profile. The OnePlus Buds Pro 3 are available now for $179. Head to oneplus.com to get your Congratulations to John Nollett for getting last episode's mystery sound right. That's a scene from the original Ghostbusters when Slimer charges down the hallway at Bill Murray's character. Slimer's roar comes from a 1977 record called BBC Sound Effects 13 Death and Horror. The specific track is called the Mad Ape and here's this episode's Mystery Sound. If you know that sound, submit your guess at the web address mystery.20k.org Anyone who guesses it right will be entered to win one of Our super soft 20,000Hz T shirts.

[Dr. David Steensma]

Doctors have been listening to the human body for thousands of years, but even with the help of a stethoscope, these sounds can sometimes be quiet or hard to read. Nowadays, the electronic stethoscope amplifies sounds to make them easier for doctors to hear.

[Dr. Daniel Weiss]

A stethoscope that has an electronic amplifier built into it can really make even the most subtle murmurs loud and clear.

[Dr. David Steensma]

For many doctors, this innovation has been a huge upgrade.

[Dr. Daniel Weiss]

When I was in my late 30s, I lost part of my hearing in my left ear, and when my old medical school stethoscope finally WORE out after 20 some years, I got an amplified one and I couldn't believe how much of a world that it opened up again for me.

[Dr. David Steensma]

In recent years, sound recording has also become an important part of medicine.

[Fran Bord]

One of the beautiful things about audio as a tool is that it's cheap, it's easy to do at the bedside, it's reproducible as many times as you want.

[Dr. David Steensma]

Compare that to an imaging system like an X ray or an mri.

[Fran Bord]

They're expensive. Not everybody can get to them all the time. You're certainly not going to do them very frequently.

[Dr. David Steensma]

And most importantly, sonic tools are really precise.

[Fran Bord]

There are imaging systems where in some circumstances they only get 8 or 12 frames per second, some up to 30 frames per second. Sound can be recorded at 44,000 samples per second, so the temporal accuracy you can get is incredible, and there's a wealth of information that's available.

[Dr. David Steensma]

Another reason these medical listening devices can be so useful is that our hearing is far from perfect.

[Fran Bord]

Our hearing is not with a flat frequency response, we don't hear all sounds equally. The best Sounds we hear are in the 1000-3000 Hz range. That's where babies cry and people talk. However, our worst hearing is at the extremes at the close to 20 Hz, which is the lowest we can hear, and close to 20,000 Hertz, which is the highest.

[Dr. David Steensma]

But some sounds in the body exist in those high and low extremes.

[Fran Bord]

Many, many of the interesting sounds are 400 Hz or less, which is the worst part of our hearing. So stethoscopes do a not bad job of getting those frequencies to our ears, but there's room for improvement. And we believe that there's information buried in the higher frequencies as well, in the higher harmonics. And if you're not capturing that with a stethoscope, you're never going to be able to see the patterns.

[Dr. David Steensma]

To augment our imperfect hearing, Daniel has helped companies develop next level stethoscopes, which are specifically designed for different parts of the body.

[Fran Bord]

So typically now, if you've had a physician listen to your carotid artery, he'll take a regular stethoscope, the same one that he uses to listen to your heart and lungs, and put it up against your neck. The problem is you won't always get all the sound that you need when you do that. We developed a version of that stethoscope that kind of looks like a bent straw, so you can really get it into the space there and get a really good sound capture.

[Dr. David Steensma]

By improving the quality of the sound that's captured, doctors can learn new things about how the body functions. Take swallowing, for example. We typically swallow hundreds of times each day without even thinking about it. But there's a lot more going on.

[Fran Bord]

Than we realize when we swallow. There's an enormously complex sequence of events, physiologically that occur.

[Dr. David Steensma]

Your trachea, also known as your windpipe.

[Fran Bord]

And your food tract, your esophagus, share a common beginning, right, the top part of your throat, and then they split. So how does the body know to let air go down into lungs and food, into the stomach, and not the other way around? So the way that happens is there is a little flap that sits closed over the esophagus, because most of the time, you're breathing and not eating. So air can go up and down. And when you swallow, as the food comes down, that common pathway, that little flap, jumps over to block the trachea so that food won't go down there, and instead it goes down the esophagus, and then it jumps back.

[Dr. David Steensma]

While all this is going on, there are quite A few sounds generated.

[Fran Bord]

There are five different stages that occur during the physiologic swallow. People tried in the 70s, I believe it was to listen to those sounds, but all they basically heard was a glorified gulp because they didn't have the proper equipment or processing to be able to hear anything. We were able to record and hear all five components clearly with our stethoscope. And we noticed that if the first three sounds are present in their proper order, there is basically never a problem. And if either one of the sounds is missing or they're out of order, then there almost always is a problem going on.

[Dr. David Steensma]

To compare, here's a swallow heard through a normal stethoscope. And here's the swallow recorded using a specialized high tech stethoscope. See if you can pick out the five different stages here. It is even slower. When Daniel and his colleagues were recording these swallows, it actually led to another discovery.

[Fran Bord]

In the course of listening to swallow sounds, we realized that we needed a timing signal. How do we know when the swallow was beginning? And we realized that every time you swallow, and now you'll pay attention to it, the next time you swallow, you'll hear a little click in your ear.

[Dr. David Steensma]

Go ahead and try this yourself. The tough part is ignoring the sound coming from your throat and only focusing on that click in your ear. When Daniel's team was studying swallowing, they wanted to use that little click to get their timings in sync. Kind of like a clapper board on a movie set.

[Dallas Taylor]

Scene six, take one.

[Fran Bord]

But how do I know that the click is the same in everybody? And how do I know the timing doesn't change if somebody has a cold or something? So we started listening to those click sounds, and our ENT said, wait a minute. We notice that sound quality changes when there are different kinds of disorders in the ear. And so we developed a special ear microphone to listen for the clicks. Forget the swallow. Now we're just listening to the clicks.

[Dr. David Steensma]

This microphone basically looks like an earbud. Here's that ear click recorded using this new tool. And again, Daniel and his colleagues discovered that this click goes away if there's any kind of blockage in the tubes that connect your middle ear and your upper throat.

[Fran Bord]

So here's something that nobody ever listened to. You don't even realize you had the click going on in your ear. So that's an example of a never used before sound that hopefully, when we finish, can now be used for making diagnoses.

[Dr. David Steensma]

These days, some stethoscopes go even further.

[Fran Bord]

There are Already stethoscope systems that have AI with FDA approved algorithms for making diagnoses.

[Dr. David Steensma]

These devices record sounds from the patient, analyze them using AI and suggest a diagnosis.

[Fran Bord]

For example, one of the companies has an AI that's FDA approved for pediatric murmurs. The accuracy of the AI was 94% and an expert pediatric cardiologist is about 88% or 89%.

[Dr. David Steensma]

In other words, AI is already beating the human experts in diagnosing this condition. As AI gets integrated into more and more medical devices, it's important for doctors to be kept in the loop about how these systems work.

[Fran Bord]

Doctors don't like black boxes. So if you give a doctor a tool and said, almost like a tricorder on Star Trek and say, put this on the chest, it'll listen and it'll, you know, boop, boop, boop, and give you a result, they don't necessarily want that. They don't want to just put some data in, get spit out an answer, and now you've got to go with it. They want to understand what is that system doing, how is it making that decision and has to make sense to them. So the first thing we realize is that we want to be able to always present the sound, both unprocessed and then with processing to help them hear the difference. They want to understand along the way what's happening and they want to be part of that.

[Dr. David Steensma]

For doctors, there's always a delicate balance between diving into the latest cutting edge technologies and remembering the important lessons from the past.

[Dr. Daniel Weiss]

Medicine is always changing and there's always so much to learn. I think being connected to that very old art, but in a contemporary, technologically sophisticated way was very appealing to me. It felt like you were connected with these ancient physicians like Laennec, like Alan Brugger, like Hippocrates, who were trying to figure out what the problem was with the patient so that they could then alleviate that suffering. So it is both an art and a science.

[Fran Bord]

I think people are aware of the usefulness of computers in making diagnoses of newer, fancier equipment that's better able to require data, I think they're a little concerned about the human touch, the human aspect of medicine perhaps being lost. I try to reassure them that that's never going to happen. There's the art and there's the science of medicine, and these are tools. They're not meant to be replacements for doctors. They're meant to be enhancements. And that's what we're trying to do.

[Dr. David Steensma]

As powerful as these new tools are, the ones we're born with are still just as relevant.

[Dr. Daniel Weiss]

When our children were young, one of our daughters developed a cough and my wife and I brought our little girl to the pediatrician and he was a lovely man and an old school diagnostician and he examined her and he said that he didn't think this cough was anything to worry about, that it would probably slowly disappear over the next few weeks. And I asked him how he knew that and he said, when you're a pediatrician, hearing coughs is like somebody who's a musician listening to an orchestra. You can pick out the individual instruments and know which one is the clarinet and which one is the oboe. And he said, this particular cough that she has, I've heard it many times. It's something that happens after they get a respiratory infection. The infection is clear, but they still have the cough as almost a habit for a while, but eventually it'll extinguish. And that's exactly what happens. So not all sound driven diagnosis is through an instrument. Sometimes it's just using the instruments that are on the side of our heads.

[Dallas Taylor]

20,000 Hz is produced out of the sound design studios of Defacto Sound. Hear [e-mail] this episode was written and.

[Dr. David Steensma]

Produced by Fran Bord and Andrew Anderson.

[Dallas Taylor]

It was story edited by Casey Emmerling. It was sound design and mixed by Jesus Zartiaga and Joel Beuter. Thanks to our guests Dr. David Steensma and Dr. Daniel Weiss. And thanks to Joseph Butera from Bon Jovi Acoustic Labs for his help on this episode. To learn more about their work, just follow the links in the show notes. I'm Dallas Taylor. Thanks for listening. The OnePlus Buds Pro 3 are top notch earbuds and this is coming from someone who's tried a lot. I've been really impressed by the sound quality thanks to the dual driver and dual DAC technology inside them. I've also found the adaptive active noise cancellation to be really useful, but there are a few other key features that caught my attention. The first is the battery Life. The Buds Pro 3 can last up to 43 hours on a single charge. On average. That's enough time to run 10 marathons, watch all of the Harry Potter movies twice, Expelliola, or listen to 96 episodes of 20,000 hertz. You're listening to 20,000 hertz and if the battery does run out, it recharges really quickly. Ten minutes of charging gives you up to 13 hours of use, and a full charge takes just 81 minutes. Next is the spatial audio, which gives you an immersive experience similar to hearing sounds in the real world. It does this by tracking your head movements so it feels like sound is coming from every direction. And then there's the case. I know it's a small thing, but it has a faux leather texture that just feels very premium. It also supports wireless charging, so I never have to think about cables. The OnePlus Buds Pro 3 are available now for just $179. For a pair of earbuds this premium, it's a great price. To grab a pair, just head to oneplus.com or tap the link in the show notes.